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Abstract
Objective
To evaluate whether oral contraceptive pill (OCP) pretreatments in gonadotropin-releasing hormone (GnRH) antagonist ovarian stimulation protocols takes positive effects on in vitro fertilization (IVF) outcomes in respect to retrieved oocyte number, oocyte maturation rate, fertilization rate, good quality embryo rate, cycle cancellation rate, pregnancy rate and clinical abortion rate.
Methods
A total of 194 cycles using GnRH antagonist protocol was performed at infertility clinic of our institute from September 1st, 2009 to February 28th, 2010. The medical records of GnRH antagonist protocols for IVF with or without OCP pretreatment in our IVF unit were retrospectively analyzed. We compared the IVF outcomes between OCP pretreated (n=41) and no pretreatment group (n=153).
Results
In cycles with OCP pretreated group, the total used dosage of gonadotropin (3019.38±1379.00 IU) were higher than that of no pretreatment group (2551.52 ± 1157.05 IU, P = 0.054). The duration of ovarian stimulation in OCP pretreated group (11.5 ± 2.0) was significantly longer than that of control group (9.5 ± 1.9, P = 0.000). The number of gained total embryo (2.8±0.9 vs. 2.5±1.0, P = 0.055) and fertilization rate (77.2% vs. 65.5%, P = 0.017) were significantly higher in OCP pretreated group. There is no significant difference in pregnancy rate between two groups (39.4% vs. 30.0%, P = 0.304).
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Fig. 1.
Histogram of IVF outcomes of GnRH antagonist protocol with or without OCP pretreatment. IVF, in vitro fertilization; GnRH, gonadotropin-releasing hormone; OCP, oral contraceptive pill; COH, controlled ovarian hyperstimulation. aStatistically significant (P-value < 0.05). bP-value = 0.055.
Table 1.
Comparison of baseline characteristics and ART outcomes
| OCP pretreated group (n = 41) | No pretreatment group (n = 153) | P-value | |
|---|---|---|---|
| Age of female (yr) | 35.8 ± 3.1 | 36.8 ± 3.5 | NS |
| Age of husband (yr) | 36.9 ± 4.0 | 38.3 ± 4.0 | 0.039 |
| BMI (kg/m2) | 21.1 ± 2.4 | 20.5 ± 1.9 | NS |
| Basal serum FSH (mIU/mL) | 9.9 ± 4.0 | 10.5 ± 2.1 | NS |
| Primary infertility (%) | 65.9 | 55.6 | NS |
| Duration of infertility (mon.) | 49.7 ± 33.3 | 52.4 ± 40.2 | NS |
| Dosage of gonadotropin (IU) | 3019.4 ± 1379.0 | 2551.5 ± 1157.1 | 0.054 |
| Duration of COH (day) | 11.5 ± 2.1 | 9.5 ± 1.9 | 0.000a |
| E2 on hCG day (pg/mL) | 1170.8 ± 1267.3 | 1086.0 ± 877.5 | NS |
| EM thickness on hCG day (mm) | 10.4 ± 2.6 | 10.0 ± 2.4 | NS |
| Number of retrieved oocyte | 7.2 ± 5.1 | 7.0 ± 5.2 | NS |
| Number of matured oocyte | 5.6 ± 4.3 | 5.1 ± 4.1 | NS |
| Oocyte maturation rate (%) | 81.1 | 75.1 | NS |
| Number of total gained embryo | 2.8 ± 0.9 | 2.5 ± 1.0 | 0.055 |
| Good quality embryo rate (%) | 26.8 | 19.1 | NS |
| Number of transferred embryo | 2.6 ± 0.9 | 2.3 ± 1.0 | NS |
| Implantation rate (%) | 10.6 | 10.5 | NS |
| Fertilization rate (%) | 77.2 ± 0.2 | 65.5 ± 0.3 | 0.017a |
| ICSI rate (%) | 75.8 | 83.1 | NS |
| Cycle cancellation rate (%) | 19.5 | 14.5 | 0.468 |
| Pregnancy rate/embryo transfer (%) | 39.4 | 30.0 | 0.304 |
| Clinical abortion rate (%) | 41.7 | 42.1 | 1.000 |
Values are presented as mean ± standard deviation. ART, assisted reproductive technology; OCP, oral contraceptive pill; NS, not statistically significant; BMI, body mass index; FSH, follicle stimulating hormone; COH, controlled ovarian hyperstimulation; E2, estradiol;EM, endometrial thickness; hCG, human chorionic gonadotropin; ICSI, intracytoplasmic sperm injection.
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